Md. Code Regs. 14.35.15.05

Current through Register Vol. 51, No. 24, December 2, 2024

Section 14.35.15.05 - Conditions for Participation-Authorized Carrier Conduct

A. An authorized carrier may not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, or sexual orientation in the administration of a qualified plan.

B. An authorized carrier shall offer insurance producer compensation for qualified plans offered through the Exchange equal to insurance producer compensation for qualified plans offered outside of the Exchange.

C. An authorized carrier shall comply with any applicable State laws and regulations regarding marketing by carriers, including:

(1) Any fair marketing standards developed jointly by the Exchange and the Commissioner under Insurance Article, § 31-115(k)(2)(x), Annotated Code of Maryland;

(2) Insurance Article, §§ 27-202 - 27-205, Annotated Code of Maryland, for insurers, nonprofit health service plans, and dental plan organizations; and

(3) Health-General Article, §19-729, Annotated Code of Maryland, for health maintenance organizations.

D. An authorized carrier and its officials, employees, agents, and representatives:

(1) Shall comply with any applicable State laws and regulations regarding marketing by carriers;

(2) Shall offer plans and plan variations with marketing names that include correct information, without omission of material fact, and do not include content that is misleading; and

(3) May not employ marketing practices or benefit designs that will have the effect of discouraging the enrollment of individuals with significant health needs in qualified plans.

E. An authorized carrier shall allow all qualified individuals and qualified employees to enroll in qualified health plans during open enrollment periods designated by the Exchange for the Individual Exchange or the employer for the SHOP Exchange.

F. An authorized carrier shall allow qualified individuals and qualified employees determined eligible for special enrollment periods by the Exchange to enroll in qualified health plans outside the open enrollment periods.

G. An authorized carrier shall implement the effective dates of coverage for the Individual Exchange established by the Exchange in accordance with COMAR 14.35.07 and COMAR 14.35.14.14 as specified in enrollment information received from the Exchange.

H. An authorized carrier shall terminate an enrollee's coverage in the Individual Exchange only in those circumstances permitted by COMAR 14.35.14.

I. An authorized carrier shall process and acknowledge enrollment and eligibility information transmitted from the Exchange in accordance with Exchange standards detailed in the System Companion Guide.

J. An authorized carrier shall reconcile enrollment and eligibility information with the Exchange no less than once a month and upon request of the Exchange in a form and manner designated by the Exchange and detailed in the system companion guide.

K. An authorized carrier shall provide a member level report to the Exchange no less than once per month, upon request of the Exchange, and in a form and manner designated by the Exchange and detailed in the system companion guide.

L. An authorized carrier shall notify the Exchange 60 days in advance of a carrier system or data change that may affect the transmission or receipt of data from the Exchange to the carrier.

M. If an applicant initiates enrollment directly with the authorized carrier for enrollment through the Individual Exchange, the authorized carrier shall direct the individual to file an application through the Individual Exchange.

N. An authorized carrier shall accept and process an enrollment for a qualified individual or qualified employee that does not include a Social Security number.

O. Designation of Plans for Re-Enrollment.

(1) If a carrier terminates a plan in accordance with 45 CFR 147.106(c), the carrier shall submit to the Exchange a template that designates a plan that is an appropriate substitute for the plan that will no longer be available in the next plan year.

(2) The substitute plan designated by the carrier shall be determined in accordance with COMAR 14.35.07.23C.

Md. Code Regs. 14.35.15.05

Regulation .05 adopted effective 46:5 Md. R. 308, eff. 3/11/2019; amended effective 51:3 Md. R. 154, eff. 2/19/2024; amended effective 51:15 Md. R. 710, eff. 8/5/2024.